脑卒中患者小腿三头肌肌张力的表面肌电特征

Study of surface electromyography characteristics of muscular tensuin of triceps surae in stroke patients

目的采用表面EMG(sEMG)法,探讨脑卒中偏瘫患者不同功能状态下小腿三头肌的sEMG变化。方法选取30例脑卒中恢复期存在小腿三头肌痉挛的偏瘫患者,分别采集患者在踝关节被动背屈牵伸过程中,伸膝位和屈膝位的健患侧内外腓肠肌以及比目鱼肌的sEMG信号,以及患者在行走5个步行周期时健患侧内外腓肠肌及比目鱼肌的sEMG信号。并对sEMG的均方根振幅(RMS)值进行分析比较。结果 (1)在踝关节被动背屈牵伸过程中:患侧内外腓肠肌的RMS值伸膝位明显高于屈膝位(均P<0.05),比目鱼肌无明显差异;同体位下内外腓肠肌以及比目鱼肌的RMS值患侧显著高于健侧(均P<0.05);伸膝位时患侧内侧腓肠肌的RMS值最高。(2)在步行运动过程中:支撑相时,健侧内外腓肠肌的RMS值高于患侧(P<0.01),比目鱼肌无差异;摆动相时,健侧内外腓肠肌以及比目鱼肌的RMS值高于患侧(均P<0.01)。支撑相时,比目鱼肌贡献度患侧高于健侧(P<0.05),而外侧腓肠肌的贡献度健侧高于患侧(P<0.05)。结论脑卒中恢复期患者在踝关节被动背屈牵伸时,腓肠肌是偏瘫患者小腿三头肌痉挛的主要因素。步行时,患侧比目鱼肌取代正常跖屈时腓肠肌成为主要步行推动肌群。

Objective To investigate the changes of surface electromyography(sEMG)changes of triceps surae in stroke patients with hemiplegia under different functional conditions by sEMG.Methods Thirty stroke patients with triceps spasm in the convalescent stage were selected.During passive dorsiflexion distraction of ankle joint,the sEMG signals of internal and external gastrocnemius muscle and soleus muscle in knee extension position and knee flexion position were collected.During five walking cycles,sEMG signals of internal and external gastrocnemius muscle and soleus muscle were also collected.The root mean square amplitude(RMS)of sEMG is analyzed and compared.Results(1)During passive dorsiflexion distraction of ankle joint,the RMS value of medial and lateral gastrocnemius muscle in knee extension position was significantly higher than that in knee flexion position(all P<0.05),but there was no significant difference in soleus muscle.The RMS values of internal and external gastrocnemius muscle and soleus muscle in the affected side were significantly higher than those in the healthy side(all P<0.05)in the same position.The RMS value of the medial gastrocnemius muscle of the affected side was the highest in the knee extension position.(2)During walking:The RMS value of internal and external gastrocnemius muscle in the healthy side was higher than that in the affected side in the stance phase(P<0.01),but there was no difference in soleus muscle.The RMS values of internal and external gastrocnemius muscle and soleus muscle in the healthy side were higher than those in the affected side(all P<0.01)in the swinging phase.In the stance phase,the contribution of soleus muscle in the affected side was higher than that in the healthy side(P<0.05),while that of the lateral gastrocnemius muscle in the healthy side was higher than that in the affected side(P<0.05).Conclusions During passive dorsiflexion distraction of ankle joint,the spasticity of gastrocnemius muscle on the affected side is greatly affected by posture in patients with stroke,while that of soleus muscle is less affected.Gastrocnemius muscle is the main factor of triceps spasm in stroke patients with hemiplegia.During walking,the affected soleus muscle replaces the gastrocnemius muscle as the main walking muscle group during normal metatarsal flexion.